Church-Related Employers Must Cover Women's Contraception

Months ago I shared here that there was a debate within the Obama Administration as to whether under the Affordable Health Care Act employers' health plans would be required to cover contraceptives for women and without co-pays. It would have to do that, and again, free of charge, if contraception were to be regarded under law as a preventative health service. Independent estimates suggested that so doing would save middle- and working-class, and poor women, hundreds of millions in out-of-pocket co-pays--often up to $50 per month per woman--and also save society-at-large in public costs related to unplanned pregnancies. Those costs are far greater, year-to-year, than the cost to employers of having to carry insurance that pays for women's contraceptives.

The Vatican

This past week, over the protests of the Church, the Obama Administration took a decision: employers' insurance must, in fact, cover women's contraception.

Like the decision of states whose adoption laws require all agencies who want public state contracts to welcome same-sex prospective adoptive couples, this decision has roiled the Church. In the state-agency cases (in states that honor same-sex partnerships and/or marriages) the Church has vehemently protested this most recent decision, and, in the equality states, the Church has broken its adoptive- and social services contracts with the states. Catholic Charities chose to abandon millions of families it had formerly served. In the case of the new contraceptives-coverage rule where there are no contracts for the Church to consider breaking, the Church has threatened suit.

As Robert Pear in the NYT writes, "The rule takes a big step to remove cost as a barrier to birth control...a longtime goal...of experts on women's health." Now, the rule does exempt some religious employers--those who hire within the religion only--but not those who employ what the law calls large numbers of people outside of the institution's affiliated faith. (Many Catholic, Jewish, and Protestant universities, social service agencies, schools, and hospitals do.) The U.S. Bishops want far broader exemptions, ones that would allow Catholic institutions to deny contraception service coverage to all employees no matter how many employees, no what percentage of non-Catholic doctors, teachers, lunchroom employees, social workers, nurses, nurses aides, etc., its institutions employ.

The Catholic University of America, Washington, DC

This situation isn't precisely like the gay couple/adoption disagreement. In that case, again, Catholic Charities chose to withdraw from existing state social service contracts in order to avoid providing services to LGBT citizens. In this new controversy, the Church alleges its religious freedom has been threatened. And yet, to a non-Catholic female employee, it's simple to see how one could feel legitimately discriminated against. And the fact is, Catholic hospitals, its larger schools and universities, for instance, believe they must hire outside the faith and actively recruit non-Catholics if, for no other reason, they employ so many people and cannot fill positions with Catholic professionals only. Yet these Catholic institutions recruit actively outside the faith also because they value a certain degree of religious and background-diversity in the ranks as a basis for good neighborhood and regional relations, and because many of their lay (and even many clerical) administrators believe an at least somewhat diverse professional mix tends toward a greater consistent professional excellence. (This is also true for many Jewish and other kinds of Christian institutions who hire broadly.)

My sense of this is that were we to exempt Church-related employers from having to provide the contraceptive coverage that every other employer must, then, in effect, society-at-large would be burdened. Society would have to subsidize the costs when any female Church-related employee so denied were to show in an emergency room with any avoidable, pregnancy-related medical condition that could have been prevented by contraception. We would be subsidizing through taxation a rather narrow, exclusively religious view as to contraception. That's, for me, untenable. And it would, for me, be unacceptable were the largest religiously-affilliated employers be Jewish institutions as well, say, Philadelphia's Einstein Hospital, L.A.'s Cedars-Sinai, or my own original teaching-home, Akiba Hebrew Academy, just west of Philadelphia whose faculty and staff was and remains religiously diverse.

Note too, that while churches themselves are not what the law calls 'public accommodations', its hospitals, day care centers, and many of its affiliated schools and other service agencies, are. They welcome people of all faiths as staff and welcome clients and patients and students of all faiths, and thrive when they do. The idea that these institutions are fundamentally private is at best suspect. They should have to live by the rules that all public accommodations live by.

So, I ask you now: given the medical, legal, social- public relations, gender, broadly economic, and professional issues attendant to this decision, what's your considered sense of this?

Jon, this is something that has troubled me for years. On the one hand, I support freedom of religious views, including allowing each set of followers to adhere to their own faith. On the other hand, I *also* believe in all of us helping others in need.

Yet in situations such as this, those two beliefs come into stark, irreconcilable conflict, an immovable object encountering an irresistible force.

Are we to force the Catholic Church (or any other religious institution) to fund insurance coverage for female employees that starkly contradict the Church's precepts -- even if you, I, and that gal over there all agree those precepts are outdated and wrong? What if the Catholic Church were somehow to obtain effective political control of America and pushed into law a prohibition on the very production of ANY birth control methods and abortion? Wouldn't we who believe in contraception and, at least in SOME cases, surely, abortion (such as rape, for pete's sake) feel violated? Can we deny that feeling of violation to our sincerely Catholic fellow Americans?

Yes, it becomes a burden on the rest of us if we exempt, in this case, the Catholic Church. It also opens a Pandora's box for other organizations demanding they not have to pay taxes, for instance, to fund something in which they don't believe. I recognize that clear and present danger -- yet I'm not *sure* I want to deny the Catholic Church to legal right to stick to its teachings.

I will, however say this: if the Church has no contractual obligation at stake, then to heck with it. Dismiss its lawsuit as the Church having no standing. It doesn't pay taxes anyway, as no recognized religious institution does. Or, conversely, tell Church leaders, "You wanna throw a dog in this fight -- you gotta pay taxes." (Which can be argued for in any case, but that's a different dogfight, isn't it?)

My considered take? Damn, Jon, I'm 60 and STILL haven't made up my mind about this stuff. When my Chinese wife went to the doc back in the 1980's and the rabbit died, I left the decision to her whether or not to have an abortion. She chose to do so, unsurprisingly, as you know. And I supported her 100% (and still do), though I never have fully decided whether I made the right -- moral -- decision or not; she would have seriously considered my view had I openly objected.

I sure as hell hope I don't get flamed for saying all the above, because I don't mean to offend anyone, no one at all. I speak only for myself, and that's what you asked us to do.

Kurt this isn't quite as cut/dried for me as is, say, the Church leaving its social service clients to hang over the issue of prospective gay adoptive parents. And I am a-ok with the exemption as it applies to Catholic employees only.

Jon, I don't recollect the incident in Tianjin, but knowing me, I don't doubt it a second, either!

As for non-Catholic employees in a Catholic organization, I have a very clear view of that, and have for decades. If a job-seeker doesn't wish to conform to the policies of a particular employer -- don't apply to that employer, or, if he/she does, then expect to be required to observe those policies, strictures, etc.

When I was a police officer and security officer, there were plenty of policies -- not to mention laws -- with which I STRONGLY disagreed. But when I voluntarily pinned on a badge and strapped on a gun, I enforced the laws -- all of them within my jurisdiction to do so. Even as I fought mightily to change or eliminate them.

Neither my Mother nor Sister smoke. I do. When I go to their homes, if I want to smoke, I go outside. Period. If they come to mine, I will be polite and not smoke even there, unless they're bitchy about it, then I figure my home's *my* castle. (I had to threaten to move Mom to a hotel in Macau when she wouldn't stop counting my cigarette butts and lecturing me about it when she came to visit.)

I don't believe in rendition, but I do believe in legitimate intelligence activities. For other reasons, I never was the least bit interested in working for an organization such as the CIA, but if I had, I would have done as I did when I was a cop and security officer -- fought from within. Though in that case I would have drawn the line at being directly involved in renditioning, enhanced interrogations, etc. and resigned instead.

Say I like to have a drink with my lunch then were I to voluntarily accept employment at a church that forbids drinking alcohol, I would follow that requirement during work hours, especially if my work was on their premises, though I wouldn't outside of those hours. But I would remain silent then -- I know I'm not going to change Baptists, Islam, etc. in that regard.

But back to the point. Don't like the Church's policies? -- then don't work for it. (I don't, and I don't. And I won't.)

Kurt I see the argument and yet I also know that, as I said above, these institutions actively recruit outside of their 'home-religion' and they do that because the institutions believe they benefit ffrom diverse recruiment policies. As such, I see no reason why, say, a yong, recruited female doctor in , say georgetown Univ Hospital---and it is a GREAT place here in DC--should not be treated as if she had been recruited by, say, Sloane-Kettering, in NYC.

The Church is sayng, in effect, that it wants all the benefits of engaging with the broader society, but is glad to deny contraception-benefits to those it actively recruited.

whether or not this is a considered take:the decision as to whether or not one used contraception is a personal and private one. seems to me the church wants to govern its employees behavior through securing government collusion to allow it to engage in a practice that would be proscribed at any other employer.If the church is unable to influence and govern its employees decision on birth control through faith then why should it ask government to do it for them by allowing the exemption of birth control from health insurance coverage?Can the employer opt out of this coverage or should the employee opt out?Interesting debate.

For me it represents the first time in a while where churches have been forced to accommodate the law of the land over and above their own religious rules. For the last forty years or so churches, in particular the Catholic, and Evangelical ones of the Christian variety have tried to exempt themselves from the laws of the land by using the religious freedom excuse. Religious freedom if taken literally would mean that we would be obliged to allow religions such as Ras Tafari to use Ja's herb for prayer with impunity, or the use of Sharia law in the case of Muslims, or how about the native Americans use of mescaline and peyote in religious ceremonies. It seems to me that Christian or traditional Roman Catholic religions seek to have all of their beliefs allowed by law and if one is not of those mainstream religions then well, your heathen practices are not "legitimate" for the very reason that I find the allowance of employees of those religions the right to their own health care to be taken over and above the religious tenets of their employers. Religions that are mainstream are not the only religions that the Constitution of the United States declares to be free from government interference, there is no specification at all on the subject. Laws that inhibit the practice of (for want of a better term) "fringe" religions are just as illegal as any law that infringes on the practice of those mainstream ones yet there are numerous examples of those types of laws already on the books. Sorry Jon, I fear I'm ranting a bit. Bottom line? I'm glad the government decided for once to back individual liberty despite pressure from religious groups. If they want to hire people that are not members of their religions then they must abide by the laws of the land even those that their religion is opposed to.

Enjoying reading the thread Jon. I don't like to give the Catholic church, or any organized religion in the United States, power over any individual, unless they cooperatively want to be a part of their organization by becoming a member of their faith and want to follow its tenants. I don't want to prevent anyone from being in any religion or being religious according to their "laws". However, if they are reaching over their area of control, with individuals that are not believers and trying to make them conform to their ideas and religious ideology, that is where I draw the line. I don't think any church has the right to dictate anything to anyone who is not one of their own. I am a firm believer of a separation of church and state. I don't want the influence. If we decide the catholic church has it going on, then how about all the other ones, perhaps the scientologists or some islamic sect? Then we are in the business of saying which one of those is true or better. Not interested. Oh, and they should all be taxed and oh, that has nothing to do to affect their influence any more than does mine as I am taxed and have little influence in our government.

So in conclusion, they should butt out. We should be allowed to have our contraception, and whatever else we need medically without the influence of some twisted organized baffoons.

I must say I have no patience for this or most other positions taken and rammed down our throats by the Catholic Church. My chief problem with the contraception ban is the implicit assumption that women are all gleefully choosing to have this illicit sex that the Church is so heated up about. However, common sense and life experience show that this is scarcely the case in America, where women, married or otherwise, are regularly cajoled and bullied into intercourse by husbands and boyfriends. This particularly - and tragically - holds true in much of poverty- and AIDS-infested Africa, where women notoriously have no input on when, and by whom, they get penetrated, infected, and knocked up. Thus it seems to me that if the Church is truly concerned with "mercy," it would place priority on providing contraceptives, and particularly condoms, to all women in order to save them from the greater wages of "sin." After all, "sin" goes a hell of a lot deeper than a woman's personal choice to engage in a little recreational sex, which should be the least of the Church's worries. I mean, in some parts of the world priests ought to hand condoms out along with the Sunday wafer, at least if they care about their flock's well-being. This should be common sense, but religion, as we know, does strange things to a person's brain.

Should be a simple argument, all institutions should follow the law of the land, period. The individual has the right to do as they see fit, according to their own conscience.... I need no institution to tell me what to believe or how to live, whether I'm a believer or not...The Church has not done such a great job with the poor and hungry, yet their dogma has led to many being poor and hungry... go figure...

history is littered with evidence of various religious institutions ability to dig in their political heels over dogma. i have to doubt this is really "over".

the church considers the morning-after birth control pill (which is included in this rule) to be an abortion drug... and we all know how dirty the church can fight when it comes to 'the A word'.

i have to wonder if they will opt to break the rules & just pay the fines... or offer only medical insurance that does not include a prescription plan.

i have this pending feeling of doom for anyone who works within these religious institutions, i fear that however the church chooses to handle their hissy fit over this rule, however they choose to dig their heels in this time, the employees will be the ones who lose.

whatever the church does, 'specially with the A word in play, they will not go gentle...

Perhaps being out of the workplace and self employed most of career leaves me a bit in the dark over this. However, no insurance company that has covered me and my spouse, has ever paid for contraception, ever. It has always been considered optional and not medically necessary, which I think is just plain wrong. Contraception for women and for men is an obligation and necessity unless entering into consensual parenthood. My take, anyway. It is very expensive and I believe that it is equally as important as a doctor prescribing anti-biotics, also very expensive, for the resultant infections caused by unprotected sex. So where is the logic there? No coverage for contraceptives but coverage for anti-biotics to fight the infections that result from not using protection. And then there is the other controversial practice that has arisen in many communities and schools where contraceptives are handed out to Jr. High students in sex ed classes. Both practical but, boy, do parents with religious beliefs object to that. Double edged sword, all that you say and that comes to mind over this super charged topic. So, if you are a devout Catholic and buy into all that the Church dictates, you should be on board with whatever the Church decides in matters concerning church law and the propagation of the faithful. Or not.

We bought our daughter her BC pills over-the-counter in Mexico, where they run about $1.50 per month. The price we pay here is outrageous. BTW, there are programs here in the US already--at least in California--that offer free BC pills. My partner tried them to control her irregular menstrual periods and got them free of charge. IUDs, however, cost about $700.00.

A bit off topic, but I have wanted to say this to a larger audience for years…

I suggest a much more radical approach to contraception services than even the federal government. Contraception should be administered universally, redirecting our focus to doing what’s best for children. Unlike nature that overproduces all forms of life—knowing that many will perish, humans have the means to be more selective in the production of new members of their species—for the sake of the children.

I used to say I would write a book someday: Contraceptives in the Water Supply, Every Alcoholic Beverage, and Every Drug and Let Them Get High and Screw All They Want, But They Must Pass a Test Before They Can Procreate. I vowed to write the book as soon as I, or some wiser person, could come up with a valid test. To date, none has been found.

I was raised Catholic and watched my mother slowly die as she followed the churches precepts and delivered children for 25 years. The only break the poor woman got was WWII when my father was overseas. There were nine of us—who lived, as my mother would say. My great-grandmother, according to family lore, was the unofficial abortionist in White Bear Lake, Minnesota in the early 1900s. She provided and abortion for her teenaged granddaughter, my mother , after she was impregnated by her father, my grandfather, a sin my mother tried to ameliorate by producing children on demand with my father until her body could not produce any more.

After several decades as an educator, watching unwanted and neglected children struggle in life, I think we have the equation backwards. Having children should be a privilege, not a right, and those desirous of parenting, through pregnancy or adoption, should be required to pass rigorous tests and meet certain criteria before being given an antidote and allowed that privilege. The conundrum is WHOSE test and WHOSE criteria, so my offering is of as little help in your discussion as it is in my quest to save the children.

What you suggest is too rational and well-considered and far too aligned with justice to wedge into the aforementioned philosophical/religious construct. We can't think that way, and I doubt that they can relate to ours.

I think that the church (aka: the boys) will do everything possible to be true to the dogma of the church. Look for adherence to policies and long held practices of the church. It changes not…and when it does often someone comes along in a few years and scraps it all so things can head backward a few centuries. (Good Try, John the 23rd. )

I don't know what will happen here. Long range? Lawsuits? I have no clue what is actually feasible to remedy the situation.

I think the best path through this thicket is around it with groups like Planned Parenthood and their facilities, regional and urban Women's centers and the National Organization for Women. The hope is that they will somehow, someway be able to provide information, contraception hope and healthcare for women. Women helping women is more likely than male-dominated institutions budging.

This is just one more example of the uneven treatment of women within the framework of many male dominated religion, political institutions and nations including our own. No contraceptives, yet Viagra is often readily provided in healthcare plans. Don't get me started...

The real problem is that your employer shouldn't have anything to do with your health insurance. It's an artifact of the tax system and it adds one more layer between patient and health care provider.

The church has the option of not providing health insurance to their employees. All the Gov't is saying is that to be eligible for tax deductions, insurance has to cover certain items.

I don't think the issue is society at large's burden. I think the issue is whether religions can exempt themselves from the law of the land at will. You note we tend to argue this about stuff in the forefront of the culture, not about whether Muslims can marry 9 year olds and Mormons can marry millions.

Where I live, the main Catholic employer in the area is the local Catholic health system. Employees of this system are unionized. They have health insurance, retirement benefits, vacation, sick time, holidays, all in all a very nice benefit package. They have training programs for employees who want to move up in the organization, including educational benefits for employees who want to work on a college degree. In addition to the benefit package, employees have decent salaries -- the janitors and receptionists are making well over minimum wage, and many nurses (largely a female profession) make very nice salaries.

Given the current economic climate in the country, millions of people, were they to go to work for this Catholic health system, would think they died and went to heaven.

On top of that, the Catholic health system has various programs to help poor people cover the costs of their medical care.

In summary, all of the things that those on the political left would want in an employer, our local Catholic health system has. Unionization, health insurance, retirement, vacation, holidays, sick time, education -- and even social responsibility -- it's all there.

But because the Catholic health system objects to paying for contraception, suddenly they are perceived as oppressors "cramming their beliefs down the throats" of suffering employees, "burdening society," "sticking their noses into people's bedrooms," and so on. This demonstrates the fanaticism of the political left, as any deviation from left-wing orthodoxy is intolerable. In other words, with the political left you have to agree with the entire "package," and any person or organization who deviates from that is denounced.

But let's look in particular at contraception and health plans. Most of the larger Catholic institutions (that hire non-Catholics) will be unionized. This means that compensation, including the provisions of the health plan, is negotiated between the union and the employer. There is no free lunch, and there is a limit to how much the employer can spend on health care. Mandating that health plans pay for contraception means that this cannot be negotiated between the union and the employer. Because the plan must pay for contraception, there will probably be something else that it doesn't pay for. Is this a decision that the federal government should make, or is it something that should be negotiated as part of the larger benefit package? Maybe the employees of an organization would rather have better dental insurance instead of fully-covered contraception. Maybe they'd rather have a smaller co-pay on drugs. Maybe they'd rather have prenatal care covered at 100 percent. None of that matters, because the feds have already made that decision for them.

I am also baffled by comments talking about Obama's "courage" in mandating that health plans pay for contraception. I'm not sure how much courage it takes to spend someone else's money.

Most baffling is the idea that not wanting to pay for contraception somehow puts Catholic organizations "in the bedrooms" of employees. It's the other way around; having the government force Catholic organizations to pay for contraception PUTS them in the bedroom. They don't want to be in the bedroom, but the government forces them to be there by forcing them to pay for contraception.

There is no such thing as a health plan that pays for everything, and every health plan has a long list of things that it doesn't pay for. So to say that Catholic organizations are terrible because they don't want to pay for that one particular thing, while so many other things ARE covered, is simply ludicrous. While millions of Americans are falling into an economic abyss, the employees of Catholic organizations enjoy some of the best benefits around, on top of decent salaries. One would think that this would buy the church some good will from the left, but it doesn't work out that way.

Just curious -- what don't you agree with? Is there something wrong with unions and employers negotiating benefit packages? Something wrong with employees and unions deciding what health benefits are most important to them?

Employers have a limit on what they spend for health insurance. Everything that's covered in the plan comes with a price tag. If a plan offers free contraception, then there's going to be something else that isn't covered.

In evaluating health insurance you have to look at the total package. You can't just say "oh no, the plan doesn't cover contraceptives, that's terrible!" Because by not covering contraception, it means that something else IS covered, given that the employer will spend a fixed amount on health insurance. If women have to pay for their own contraception, then there's something else in the plan that they don't have to pay for. And maybe they'd rather have the choice instead of the federal government making the choice for them.

I once had a health plan that didn't cover injections. Any time the doctor approached you with syringe and needle in hand, that wasn't covered. Most other things were covered, and overall it was a pretty good plan. And I didn't accuse the employer of "sticking his head in my veins" because the health plan didn't cover injections.

Jonathan - This may be a 'bitter pill to swallow', but, I believe that the church (and any other religious institutions - but - mostly the catholic church) needs to mind it's own business. Stick to collecting money and whipping up guilt and a sense of superiority in it's sheeple. covering the cost of birth control is one of the first pro-active suggestions i've heard in a long time. Hallelujah!

This post highlights everything that is wrong with employer-based health care. I was once caught in this mess. When I was pregnant with my kids, I worked for a medical software company that had a big contract with a Catholic hospital system. No surprise, our company benefits also came from this Catholic hospital system. Birth control was covered, but all the hospitals that were "in network" were Catholic, which meant all sorts of rigamarole and a trip to an "out of network" hospital for me to get a tubal when I was done having babies. It was infuriating how far down the insurance food chain the insidious fingers of Catholic sexual control can reach.

I was a non-Catholic, working for a non-religious company, but still, still, the damn Catholics have their fingers in my bedroom, and in my private baby-making choices with my husband.

I have REALLY mixed feelings on this just like Kurt does. I worked for a large Catholic hospital for a number of years and they did not pay for my pills, nor could I purchase them at the onsite pharmacy. I thought of it more as an inconvenience. In the context of today's world, things are so different now as insurers are paying for less and less of EVERYTHING. How about approaching the problem from a different way and REALLY solving it, like getting away from our atrocious employer-based health care system in this country? That's the REAL problem. I would LOVE to have the coverage BACK I had at the Catholic hospital. I can't get coverage for myself on the open market due to an eye condition, I'm on my husband's outrageously expensive plan, and it just goes up and up and up and pays for less and less and less. We don't have dental insurance anymore because his plan for dental family coverage is about three or four hundred a month.

Amy thank you. Until we have, in effect, Medicare for All, and unless somhow Catholic and Jewish hospitals are not, under law, considered public accommodations, I see no real better way than what this president has done as to this.

When the church gets involved in contraception, it gets ugly. I think family planning is best left to families, and Planned parenthood really beats the unplanned variety. A pill is a lot less expensive than an accidental pregnancy. And the life of an unwanted child can be real hell.

And when liberals, rather illiberals, like "Beauty" want to license other women to have kids and talk about contraceptives in water and such, they are playing with a real fascism. She can keep her nose out of individuals' lives thank you very much.